The evidence is all around us

June 17, 2019

Cambie Trial Update

Universal Public Health is Guaranteed with Single-Payer, Public Insurance

Over the last month, evidence presented by the British Columbia Attorney General in the Cambie case has hammered home one indisputable fact: Public, single-payer insurance for health care is absolutely necessary to ensure that health care is delivered based on need and not on the ability to pay.

This lawsuit at the Supreme Court in British Columbia launched by Brian Day against BC’s ban on private insurance and extra-billing uses long wait times as evidence that individuals should have the right to seek care outside the public system. Day has no evidence that the remedy he seeks solves the problem he has brought forward. Instead his lawyers are trying to prove that a second private tier of care would do no harm to the public system. That’s simply not true.

The government of British Columbia maintains that these provisions exist to ensure the province conforms to the Canada Health Act, and they have brought several expert witnesses forward this past month to prove it. They have illustrated that the addition of private insurance would have a strong impact on the equity of our health care system. The defence witnesses have presented evidence from around the world as well as from right here in Canada to demonstrate that adding a private tier with higher fees and duplicate private insurance distorts access in favour of those with more money. Evidence has also shown that two-tier health care delivery has a strong negative effect on the quality of care, the cost of care and indeed on overall wait times for medical procedures.

Testimony from Australia outlined that the addition of a second private tier sees wealthier citizens access faster and better care, creating longer wait times and staff shortages in the public system. And testimony illustrating the experience in Ireland showed that those with access to private medical insurance not only had better access to care, they used the health care system more often. This testimony also showed that the private system has higher costs. In Manitoba, when private clinics were allowed to charge facility fees for cataract surgery, wait times increased in the public system as physicians opted to perform this procedure in the higher-paying facilities.

Much evidence has also been presented to show the high cost of private insurance and the fact that it requires a strong regulatory regime. This proved to be an issue in Ireland where the addition of private insurance has led to difficulties in regulation to control its negative impacts. One expert witness pointed out that Canada has no regulatory regime in place to control private insurers. As a result, the negative impact in Canada of market-driven medical insurance would be even greater than in other countries where private insurers operate within a strong regulatory environment.

When claiming that for-profit care would shorten wait times, the European systems to which Day points have much different regimes and are not comparable. As pointed out by one expert from the United Kingdom, improvements in wait times for elective surgeries were made only through a large public investment which ended up subsidizing the private for-profit surgical clinics. Just because some countries with two-tier systems have shorter wait times does not in any way lead to a conclusion that shorter wait times are a result of a two-tier delivery structure.

After months of evidence from Brian Day and his co-plaintiffs, it has been gratifying to listen to the expertise brought together by the defence and the intervenors that confirm the importance of public, universal health care delivered under public, single-payer insurance. Outside the courtroom this week, the same principle was confirmed. The Advisory Council on the Implementation of National Pharmacare stated that the only way to ensure all Canadians have access to prescription medication and have comprehensive drug coverage is to implement a universal, single-payer pharmacare program. The Council also pointed out that this type of program will save Canadians billions of dollars.